Payment-Based U&R Service
A number of programs can help reduce the cost of dialysis. But it’s not as simple as choosing a service or a vendor. Many other programs utilize abitrary derivatives of U&R and benefit limitations which can be difficult to defend if appealed. DCC’s Payment-based U&R program addresses both of these concerns.
Our methodology is based on the average revenue per treatment actually received by the nation’s two largest providers of dialysis services as reported in SEC filings. We look at every client as a unique case. This allows us to review all aspects of each case including, but not limited to plan language, treatment costs, location, risk tolerance, and other financial and case-specific considerations. Consequently, our Payment-based U&R program delivers significant savings by using providers’ own payment data as a basis for reimbursement. There is no stronger or more defensible U&R methodology than the actual payments received from all payer sources.
When combined with our proprietary plan language, members can be protected from balance billing and reimbursements can be applied to qualified claims, resulting in billed charges being reduced by more than 80%.
Key Features
- Proprietary plan language allows U&R reimbursement for qualified claims both in-network and out-of-network claims.
- Our language supports fiduciary discretion, which supports multiple reimbursement options for each plan and members’ unique circumstances. The administrator is not locked into a single method of cost containment for all members regardless of needs or situation.
- Ease of use after initial program implementation.
- Not arbitrary. Reimbursements based on providers own payment reporting.
- Appropriate for use in ERISA, Taft-Hartley, and other plan environments.
Benefits
* 2009 DCC Data.
